The occurrence of diversion colitis in patients with a sigmoid neovagina

Toolenaar, Toon A.M.; Freundt, Ingrid; Huikeshoven, Frans J.M.; Drogendijk, A. C.; Jeekel, Hans; Chadha-Ajwani, Savi

doi:10.1016/0046-8177(93)90134-3

Cited by 55 publications

(33 citation statements)

References 14 publications

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“…Also, diversion colitis did not occur. This is a rare disorder of unknown etiology that may occur after isolation of an intestinal segment from the fecal stream (29). The risk of adenocarcinoma of the intestinal neovagina was reported and found to be rare and lower than the risk of cancer after Abbe-McIndoe procedure (30).…”

Section: Discussionmentioning

confidence: 99%

Surgical and functional outcomes of sigmoid vaginoplasty among patients with variants of disorders of sex development

2012

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PURPOSE:To assess the use of sigmoid colon in vaginal reconstruction of some patients with disorders of sex development. MATERIALS AND METHODS: The study included 31 patients with disorders of sex development of various causes. All were reared as females. Female gender was decided for all cases after complete medical assessment. All patients underwent sigmoid vaginoplasty. Assessment of surgical and functional outcomes was carried out in a follow up period of up to 6 years. RESULTS: The preoperative diagnoses included mullerian aplasia (16 cases), androgen insensitivity syndrome (12 cases) and previous failed vaginoplasty (3 cases). Associated surgical procedures were gonadectomy in 5 cases and gonadectomy combined with clitoroplasty and vulvoplasty in 7 cases. No intra-operative or early postoperative complications occurred. A cosmetic neovagina with adequate size was achieved in all cases. Long term follow up showed introital stenosis in 4 cases (12.9 %). Two of them responded to vaginal dilatation. The third one needed y-v plasty while the fourth one presented by acute abdomen secondary to ruptured vagina and was submitted to urgent laparotomy. Mucosal prolapse occurred in 1 case (3.2%). Reoperation rate was 9.6%. Sexual satisfaction was achieved among 9 sexually active cases. The subjective satisfaction score of the surgical outcome was 8.03. CONCLUSIONS: For patients with disorders of sex development of various etiologies, sigmoid vaginoplasty is the preferred technique for vaginal replacement. It is a safe technique that provides the patient with a cosmetic neovagina of adequate caliber and a satisfactory functional outcome

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Section: Discussionmentioning

confidence: 99%

Surgical and functional outcomes of sigmoid vaginoplasty among patients with variants of disorders of sex development

2012

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“…Therefore, in this study no selectivity between malignant and normal urothelial cells was demonstrated, suggesting that the mechanism of growth inhibition is not exclusively due to malignant transformation. This is in contrast to the selectivity found with polyunsaturated fatty acids [24]. Furthermore, the paradoxical effect of SCFA reported in the colon where butyrate stimulates proliferation of normal basal crypt cells [20] but inhibits transformed colonic cell lines [25] is not seen between normal and transformed urothelial cells.…”

Section: Discussionmentioning

confidence: 86%

The effect of short-chain fatty acids butyrate, propionate, and acetate on urothelial cell kinetics in vitro: potential therapy in augmentation cystoplasty

Dyer¹,

Featherstone²,

Solomon

et al. 2005

Ped Surgery Int

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The intestinal element of enterocystoplasty is affected by chronic inflammatory changes, which lead to excess mucus production, urinary tract infections, and stone formation. There is also an increased risk of malignancy. These inflammatory changes may be due to diversion colitis, which affects colonic segments excluded from the faecal stream and likewise may respond to intraluminal short-chain fatty acid (SCFA) therapy. The SCFAs have interesting antiproliferative, differentiating, and pro-apoptotic effects, which are protective against colorectal cancer and may influence the risk of malignancy in enterocystoplasty. Before intravesical therapy can be considered, the effect on normal urothelium must be investigated. Primary urothelial cells cultured from biopsy specimens and transformed urothelial (RT112 and MGH-U1) and intestinal cell lines (HT29 and CaCo-2) were incubated with SCFAs. The 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay was used to measure the residual viable biomass to assess cell proliferation. Proliferation of primary and transformed urothelial cells in culture was inhibited by all SCFAs in a similar time- and dose-dependent manner. The concentration of SCFA required to inhibit growth of primary cells by 50% (IC50) was 20 mM of butyrate, 120 mM of propionate, and 240 mM of acetate after incubation for 1 h. After 72 h the IC50 was 2 mM of butyrate, 4 mM of propionate, and 20 mM of acetate. Transformed urothelial and colon cancer cell lines demonstrated similar growth inhibition. Butyrate was the most potent inhibitor of cell proliferation, followed by propionate and then acetate. Growth inhibition is not an immediate cytotoxic effect, and urothelial cells show a degree of adaptation to butyrate and growth recovery after incubation with butyrate. In conclusion, butyrate- and propionate-induced growth inhibition is potentially clinically significant and may have therapeutically beneficial implications in vivo.

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“…The use of an isolated segment of the sigmoid colon for vaginal construction has also been reported to yield satisfying post-operative outcomes [3,4]. However, some reports point at major intra-and postoperative complications such as necrosis of the sigmoid graft, intestinal anastomosis dehiscence, prolapse of the neovagina or persistent vaginal outflow [2,7,17]. The present technique based on the method by Vecchietti [18] in its laparoscopic modification has been shown to be a safe and quick procedure with minor intra-and post-operative complications [6,10].…”

Section: Discussionmentioning

confidence: 99%

Long-term outcome after laparoscopic creation of a neovagina in patients with Mayer-Rokitansky-Küster-Hauser syndrome by a modified Vecchietti procedure

Keckstein¹,

Kandolf²,

Rauter³

et al. 2007

Gynecol Surg

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Several conservative and surgical methods have been proposed for patients with Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome. The technique described by Vecchietti is a combination of both dilatation and surgery. We describe a minimally invasive modification of this approach including dissection of the vesico-rectal septum and present long-term patient outcome. Eight patients who underwent surgery at our department between 1996 and 2005 for MRKH syndrome were included in the present analysis. Post-operative follow-up and a semi-structured telephone interview were performed to obtain information on neovaginal functionality, immediate and long-term postoperative outcome, sexual function and physiological and psychological well-being evaluated on a 10-point scale and by the Sintonen 15D questionnaire. After a median postoperative (median operation time: 88 min, range: 63-116 min) follow-up period of 40.3 months (range: 18-84 months) without major complications and a median post-operative stay of 13.8 days (range: 6-15 days), a functional neovagina was created in seven of eight patients. Median vaginal length at the time of discharge from the hospital ranged between 7 and 10 cm (median: 9.6 cm) and reached 11.5 cm (range: 5-15 cm) at the time of evaluation. Except for one patient who neither had regular sexual intercourse nor used the vaginal dilator, sexual intercourse was quoted as satisfactory in six cases (one patient still used the dilator only). Patients reported an improvement of quality of life (mean: 8.1, range: 5-10) and self-confidence (8.1, range: 5-10) and general well-being evaluated by the Sintonen 15D questionnaire (average score of 1.8, SD= 0.06). The laparoscopic-assisted Vecchietti procedure with dissection of the vesico-rectal septum is a safe and effective method for creation of a neovagina in MRKH patients.

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The occurrence of diversion colitis in patients with a sigmoid neovagina

Cited by 55 publications

References 14 publications

Surgical and functional outcomes of sigmoid vaginoplasty among patients with variants of disorders of sex development

Surgical and functional outcomes of sigmoid vaginoplasty among patients with variants of disorders of sex development

The effect of short-chain fatty acids butyrate, propionate, and acetate on urothelial cell kinetics in vitro: potential therapy in augmentation cystoplasty

Long-term outcome after laparoscopic creation of a neovagina in patients with Mayer-Rokitansky-Küster-Hauser syndrome by a modified Vecchietti procedure

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